MAQ Subsequent Fund Form 2181 Instructions | OMB Approval No. ####-#### | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Expiration Date MM/DD/YYYY | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Application Instructions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
SBA invites eligible private entitites considering the Small Business Investment Company (SBIC) program to submit an application for License (Form 2181). For an initial application to be considered complete and ready for review, all elements and attachments listed in the Management Assessment Questionnaire (MAQ) and related exhibits must be submitted along with the requisition application fee paid. SBA requires all license application fees be remitted via the Pay.Gov website: https://www.pay.gov/public/home. Select "Small Business Administration" under "See All Agencies", then click on "SBIC Fees" and fill out the pop-up form. You will be contacted by SBA when your fee payment has cleared. All forms are available on SBA.gov/partners/sbics/forms-guides. Applications are emailed to SBIC_Applications@SBA.gov. All applicants will receive confirmation of receipt of an application within 2 - 4 business days of submission. |
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Potential applicants may submit an optional one-time Short Form 2181 ("Pre-screen") and request a pre-screen interview without paying the initial licensing fee. The Short Form 2181 and pre-screen interview request should be emailed to SBIC_Applications@SBA.gov with "Pre-Screen Request" in the email subject line. The Short Form 2181 is also available on SBA.gov/partners/sbics/forms-guides. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Qualifying Subsequent Fund License Applications | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
SBA invites qualified subsquent fund license applicants to submit an alternative Subsequent Funds MAQ along with Exhibits for expedited subsequent fund licensing. For application to be considered complete and ready for review, all elements and attachments listed in the Subsequent Fund MAQ and Exhibit As through Exhibit D along with the requisition application fee paid at https://www.pay.gov/public/home. All forms are available on SBA.gov/partners/sbics/forms-guides. Applications are emailed to SBIC_Applications@SBA.gov. All applicants will receive confirmation of receipt of an application within 2 - 4 business days of submission. |
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Licensing Process | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
After SBA reviews the application materials and completes operational and investment due diligence, the Applicant will be invited to interview before the investment committee or notified of the Agency's decision to decline to proceed with an interview. Following the interview, the Investment Committee will vote to "Green Light" the applicant to raise capital and proceed to submit final legal documents and final licensing fee when prepared to hold a first close. The Investment Committee will recommend its "Green Light" decision to SBA Agency Licensing Committee for concurrence or non-concurred. If Agency Licensing Committee and the SBA Administrator concur with a decision by the Investment Committee to grant a "Green Light", the Applicant will be notified of the decision along with the Agency's maximimum leverage commitment available to the Applicant following licensure. When the Green Lit Applicant is ready to hold a first close, it should submit all final versions of legal documents including redline copies of any draft documents submitted with the MAQ. Additionally, the Applicant must submit Exhibit E, the Legal Document Certification, and Exhibit F, the Capital Certificate, along with the Final Licensing fee. |
Subsequent Fund Application | OMB Approval No. ####-#### | OMB Approval No. ####-#### | ||||||||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | Expiration Date MM/DD/YYYY | Expiration Date MM/DD/YYYY | |||||||||||||||||||||||||||||||||||||||||
This subsequent fund "Certification" page must be signed by all principals of the applicant. The entire Subsequent Fund Application MAQ and all requested attachments must be completed in full by all applicants qualifying for expedited subsequent fund processing. | ||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Name of Applicant: | License no.: 01/23-4567 | ||||||||||||||||||||||||||||||||||||||||||
Management Teams that are already operating one or more licensed SBICs ("Management Team") must be in good operational and regulatory compliance standing with SBA in order to submit a license application for a subsequent fund. Subsequent fund license applicants must have at least two full years of operations from date of licensing of the most recently licensed SBIC (a longer or shorter operating history may be merited based on track record and prior performance). The financial performance and portfolio valuations of the current licensee(s) must demonstrate adequate coverage for any outstanding SBA Leverage. The current licensee(s) must also be able to present a clean audit opinion from the SBIC’s independent public accountant, covering the most recent, full year of operations, and no unresolved regulatory violations for the most recent SBA exam covering a period ended within 12 months of the request being filed. SBA will consider a series of factors when determining whether a subsequent fund applicant has demonstrated a commitment to best practices within the SBIC program. Please note that existing license holders applying for an SBICCT license for the first time are not eligible for expedited subsequent fund processing. |
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The applicant certifies that all of the information provided in the Form 2181, related exhibits and any other information submitted in connection with this application is true, correct and complete to the best of the applicant's knowledge. By selecting "✓" next to each of the 11 items listed below related to eligibility for expedited subsequent fund license processing, each principal and Control Person of the applicant certifies that, to the best of their knowledge, they meet all elements of such item to be considered for expedited subsequent fund license processing. The applicant represents and warrants that if the applicant, principals, and/or Control Persons become aware of any facts or of the occurrence or impending occurrence of any event that would cause one or more of applicant's representations and warranties contained below to be or to become untrue, the applicant shall immediately notify SBA in writing. The applicant understands that knowingly making a false statement is a violation of Federal law and could result in criminal prosecution under 18 USC §§ 287, 371, 1001, 1006, and 1014, including fines of up to $1 million and up to 30 years imprisonment, 15 USC §§ 645 and 687(f), civil penalties under 31 U.S.C. § 3729, government-wide debarment or suspension, and denial, suspension, or revocation of a Small Business Investment Company license. |
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1 | Consistent strategy and fund size—the Management Team’s targeted Regulatory Capital to be raised is ≤133% the size of their most recent SBIC fund (inflation adjustments will be considered), and will have the same asset class and investment strategy as the most recent SBIC license issued to the Management Team. |
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Regulatory Capital for most recent SBIC (at final close): | $- | |||||||||||||||||||||||||||||||||||||||||||
Targeted Regulatory Capital for proposed fund: | $- | |||||||||||||||||||||||||||||||||||||||||||
2 | Clean Regulatory History—no major findings, significant “other matters” or unresolved “other matters” related to any licensees managed by the Management Team in the previous ten years. | |||||||||||||||||||||||||||||||||||||||||||
3 | Consistent LP-GP Dynamics—no new limited partner will represent ≥33% of the Private Capital of the licensee upon reaching final close at target fund size or hard cap. The two largest investors (in terms of committed capital) in the Management Team’s most recent SBIC have verbally committed to invest in the new fund pending receipt of license. The most recent Limited Partnership Agreement of the active Licensee and all Side Letters will have no substantive changes for the applicant fund. | |||||||||||||||||||||||||||||||||||||||||||
4 | Investment Performance Stability—the most recent licensee net distributions to paid-in capital (DPI) and net total value to paid-in capital (TVPI) are at or above median vintage year and strategy performance benchmarks for the prior three quarters. The principals of the applicant are not managing a licensee in default or with Capital Impairment (CIP) exceeding the amount specified in 13 C.F.R. § 107.1830(c). | |||||||||||||||||||||||||||||||||||||||||||
5 | Consistent or Reduced Leverage Management— the applicant is requesting a leverage to Private Capital ratio ≤ the Management Team’s current or most recent SBIC licensee at target fund size or hard cap. | |||||||||||||||||||||||||||||||||||||||||||
6 | Firm stability—subject to SBA’s determination, no material changes to the broader firm, to include resignations, terminations, or retirements by members of the Management Team, investment committee, broader investment team, or key finance and operations personnel that have a material adverse impact on the stability of the SBIC. | |||||||||||||||||||||||||||||||||||||||||||
7 | Promotions from within—demonstration of a commercially reasonable effort of promoting internal investment team talent from within the firm/organization sponsoring the license. | |||||||||||||||||||||||||||||||||||||||||||
8 | Inclusive equity—demonstration of a commercially reasonable effort of the appropriate/increased sharing of carry and/or management company economics with promoted talent or distribution of equitable or increasingly equitable economics among the partnership. | |||||||||||||||||||||||||||||||||||||||||||
9 | FBI Criminal and IRS Background Check No Findings—the sponsoring entity and all principals of the Licensee do not have an FBI criminal record and do not have IRS violations from the date of their most recent SBIC fund licensure. | |||||||||||||||||||||||||||||||||||||||||||
10 | No Outstanding or Unresolved Material Litigation Matters—no outstanding or unresolved litigation matters involving allegations of dishonesty, fraud, or breach of fiduciary duty or otherwise requiring a report under § 107.660(c) or (d) as to a prior Licensee, the prospective Applicant’s general partner, or any other person who was required by SBA to complete a personal history statement in connection with the license application. | |||||||||||||||||||||||||||||||||||||||||||
11 | No Outstanding Tax Liens—on the principals applying to manage the licensee, on the most recent or active licensee, and on the sponsoring entity of the licensee. | |||||||||||||||||||||||||||||||||||||||||||
INSTRUCTIONS | ||||||||||||||||||||||||||||||||||||||||||||
This form must be signed by all principals of the applicant certifying the information provided related to expedited subsequent fund qualification is true, correct and complete to the best of the applicant's knowledge. SBA will accept an encrypted digital signature available by going to "Info" --> "Protect Workbook" --> "Digital Signature." Alternatively, SBA will accept a PDF version with approved digital signatures along with the completed Excel workbook. If all 11 statements above are answered in the affirmative as indicated by a "✓", the applicant may: - proceed to answer the following subsequent fund narrative questions in lieu of the full "Narrative" tab. - complete the "investment track record" tab for only new principals of the applicant not previously named in the most recent license application. - submit bios on the "Principal Bios" tab for only new principals of the applicant not previously named in the most recent license application. - skip the "Small Business Impact" and "Covenant Default" tabs. - complete the "Firm and Service provider" tab for only new service providers or changes of address and/or contact information. - complete the "References" tab for only new principals of the applicant not previously named in the most recent license application. |
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Applicant Fund Name | ||||||
Authorization to Release Information to Interested Investors | ||||||
From time to time, the SBIC Program receives inquiries from parties who may wish to consider investing in an SBIC license applicant. Information is shared ONLY for those applicants that have received a "green light" letter. If your fund receives a “green light” letter and you would like SBA to share your fund's name, contact information, target fund size, and the Applicant Overview Information with interested investors, please make an indication below. If no indication is made, SBA will NOT share your information with interested investors. The information in the fund profile below is being pulled from other parts of this workbook. However, you are welcome to edit the profile on this page as you see fit. |
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Yes, we authorize SBA to share the information included below and on the 'Overview' PAGE ONLY with interested investors. | ||||||
No, we do not authorize SBA to provide information about our fund to interested investors. | ||||||
Fund Profile for Release: | ||||||
Applicant Name: | Applicant Fund Name | |||||
Contact Person: | ||||||
Main Phone: | ||||||
Main E-mail: | ||||||
Website: | ||||||
Target Fund Size: | ||||||
License Type: | ||||||
SBIC Critical Technology Initiative Applicants ONLY Statement of Notice and Consent | ||||||
Applicant for SBIC Critical Technologies Initiative (SBICCT) | ||||||
This Applicant to the SBIC Critical Technologies Initiative (SBICCT) and its Principals acknowledge that this SBIC license application, as well as information, documents, exhibits and correspondence submitted with and in support of this license application will be shared with the U.S. Department of Defense and its agents (collectively, “DoD”) for the purpose of evaluating this license application. Additionally, pursuant to the SBA’s System of Records Notice, information gathered by and reports submitted to SBA during licensure will also be shared with DoD for oversight and compliance evaluation purposes. |
Applicant Fund Name: Fund Overview | ||||||||||
Applicant Overview Information | ||||||||||
License Type Requested | Accrual SBIC | |||||||||
Requesting SBICCT Consideration? | Yes | |||||||||
SBICCT Areas Covered | ||||||||||
Investment Vehicle | Applicant Fund Name | |||||||||
Investment Firm/Organization | [Applicant Firm Name] | |||||||||
Manager Registered RIA? | No | |||||||||
Fund Vintage Year | 20xx | |||||||||
Fund Jurisdication / Fund Structure | Delaware | Limited Partnership | ||||||||
Minimum Fund Size to Close | ||||||||||
Target Fund Size / Hard Cap | $ Target | $ Hard Cap | ||||||||
Amount Raised | $ | Enter this info for Final License Application | ||||||||
Paid in Capital | $ | |||||||||
Number of Closings Completed | ||||||||||
Date of First Close | dd/mm/yyyy | |||||||||
Minimum L.P. Investment Size | $ | |||||||||
Investment from Sponsor % | $ | % | $ | ||||||||
Investment Period (years) | x | |||||||||
Fund Term (years) | x | |||||||||
Target First Close Date | dd/mm/yyyy | |||||||||
Target Final Close Date | dd/mm/yyyy | |||||||||
Fund Style | Private Equity | |||||||||
Fund Strategy | Hybrid Growth | |||||||||
Security Allocation Targets | (i.e. 30% equity co-investment, 30% direct equity, 40% debt) | |||||||||
Geographic/Regional Focus | U.S. Nationwide | |||||||||
Industry(s) of Focus | Healthcare | |||||||||
Pharma, Biotech & Life Sciences | ||||||||||
Target Fund Return (Net) | Net IRR Range | Low % | High % | Net MOIC Range | Low #.#X | High #.#X | ||||
Target Fund Leverage (Requested Leverage) | Dollars | $ | Ratio to Private Capital % | % | ||||||
Annual Management Fee | Example: Initial Investment Period = 2% of Unreduced Regulatory Capital plus Assumed Leverage; After the Initial Investment Period = 2% of the cost of loans and investments for all “active” portfolio companies. | |||||||||
Other Fees | description and % | |||||||||
Carried Interest | % | |||||||||
Preferred Return (if applicable) | % | |||||||||
Fund's Primary Benchmark | ||||||||||
Investment Principals | Last Name, First Name ; Last Name, First Name | |||||||||
Key Person(s) | Last Name, First Name ; Last Name, First Name | |||||||||
SUBMISSION DATES | ||||||||||
Pre-screen Submission Date | dd/mm/yyyy | |||||||||
MAQ Submission Date | dd/mm/yyyy | |||||||||
FOR INTERNAL SBA USE ONLY -- Applicant Preliminary Summary | ||||||||||
Preliminary Advantages | ||||||||||
Preliminary Issues | ||||||||||
Subsequent Fund Application | OMB Approval No. ####-#### | OMB Approval No. ####-#### | |||||||||||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | Expiration Date MM/DD/YYYY | Expiration Date MM/DD/YYYY | ||||||||||||||||||||||||||||||||||||||||||||
The subsequent fund application sheet and all requested attachments must be completed in full by all applicants qualifying for expedited subsequent fund processing. | |||||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Name of Applicant: | License no.: 01/23-4567 | |||||||||||||||||||||||||||||||||||||||||||||
1 | Investment Strategy | ||||||||||||||||||||||||||||||||||||||||||||||
1.1 | Investment Strategy, Allocation and Transaction Types | ||||||||||||||||||||||||||||||||||||||||||||||
Asset class and strategy is the same as previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Investment mix (funds, directs, equity, debt etc.)s is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Geographic and industry focus is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Stage of investment is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Target portfolio company size is the same as previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Investment deal size is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Ownership/control approach is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Lead, Co-Lead, Co-investor, Sole investor approach is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Investment pace is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
For all of the above for which you did not select "✓", please describe the differences and the rationale for the changes below. | |||||||||||||||||||||||||||||||||||||||||||||||
Response here. Limit to 500 words. | |||||||||||||||||||||||||||||||||||||||||||||||
1.2 | Approach to Portfolio Construction | ||||||||||||||||||||||||||||||||||||||||||||||
Allocation Policy is the same as previously licensed fund | |||||||||||||||||||||||||||||||||||||||||||||||
Targeted range for the number of portfolio company investments is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Approach to follow-on investments (if applicable) is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
Approach to reserves management and recycling is the same as the previously licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
For all of the above for which you did not select "✓", please describe the differences and the rationale for the changes below. | |||||||||||||||||||||||||||||||||||||||||||||||
Response here. Limit to 500 words. | |||||||||||||||||||||||||||||||||||||||||||||||
1.3 | Restricted Use of Federal Funds | ||||||||||||||||||||||||||||||||||||||||||||||
The following categories would result in either criminal liability for the SBIC and its managers or are otherwise prohibited under the program: Human Trafficking, Pornography, Tobacco, Federally Illegal Substances, and International Reinvestment. Will you restrict from investing in the following areas? | |||||||||||||||||||||||||||||||||||||||||||||||
2 | Firm and Team | ||||||||||||||||||||||||||||||||||||||||||||||
2.1 | Firm Dynamics | ||||||||||||||||||||||||||||||||||||||||||||||
If applicable, please describe any material changes to your firm since the approval of your last SBIC license. | |||||||||||||||||||||||||||||||||||||||||||||||
2.2 | Team | ||||||||||||||||||||||||||||||||||||||||||||||
Briefly describe changes to the team including departures, new joiners, and promotions since receipt of the last SBIC license, if applicable. Please include approximate dates when changes occurred and the context surrounding the changes. | |||||||||||||||||||||||||||||||||||||||||||||||
2.3 | Team Cohesion | ||||||||||||||||||||||||||||||||||||||||||||||
Are there any known conditions (health, litigation, financial, personal, etc.) of any of the Principals that might affect their ability to execute their duties to the firm or the SBIC? If yes, please provide an explanation below. | |||||||||||||||||||||||||||||||||||||||||||||||
3 | Investment Process | ||||||||||||||||||||||||||||||||||||||||||||||
3.1 | Investment Process Changes | ||||||||||||||||||||||||||||||||||||||||||||||
If applicable, please describe any changes to your investment process adopted since receipt of the most recent license or changes you intend to implement in this subsequent fund. Clearly indicated whether changes described are already in place or you intend to implement. If already in place, when did the changes take effect? | |||||||||||||||||||||||||||||||||||||||||||||||
3.2 | Rationale for Process Changes | ||||||||||||||||||||||||||||||||||||||||||||||
If changes are described in 3.1, please describe the context and rationale for implementing changes. | |||||||||||||||||||||||||||||||||||||||||||||||
4 | Portfolio Management & Monitoring | ||||||||||||||||||||||||||||||||||||||||||||||
4.1 | Investment Monitoring | ||||||||||||||||||||||||||||||||||||||||||||||
Since receipt of your most receipt license, have you made changes to or do you intent to make changes to your process for monitoring investments? Please select "no change", "change implemented", "intend to change" for each item listed below. Describe in the space below the rationale for any changes. For changes already implemented, please provide approximate dates changes when into effect. | |||||||||||||||||||||||||||||||||||||||||||||||
Reporting required of portfolio companies | |||||||||||||||||||||||||||||||||||||||||||||||
Firm’s approach to board representation | |||||||||||||||||||||||||||||||||||||||||||||||
Number of deals each principal will be responsible for at peak | |||||||||||||||||||||||||||||||||||||||||||||||
Periodicity of portfolio reviews | |||||||||||||||||||||||||||||||||||||||||||||||
Level of engagement with portfolio company management | |||||||||||||||||||||||||||||||||||||||||||||||
Consulting services to or value-added support to portfolio companies | |||||||||||||||||||||||||||||||||||||||||||||||
4.2 | Underperforming Investments | ||||||||||||||||||||||||||||||||||||||||||||||
Describe in the space below all underperforming investments, if applicable. Explain the measures you are taking to turn around poor-performing investments, decline follow-on funding or sell-off your position. | |||||||||||||||||||||||||||||||||||||||||||||||
5 | Fund Economics | ||||||||||||||||||||||||||||||||||||||||||||||
5.1 | Carried Interest | ||||||||||||||||||||||||||||||||||||||||||||||
If applicable, please describe changes to the applicant fund's carried interest provisions including calculation changes, vesting policy and allocation of carried interest. Explain how these provisions compare with your previous funds and rationale for any changes. | |||||||||||||||||||||||||||||||||||||||||||||||
5.2 | Management Fee | ||||||||||||||||||||||||||||||||||||||||||||||
If applicable, describe changes to the formula you will use to calculate the management fee that the SBIC will be charged and rationale for the changes. | |||||||||||||||||||||||||||||||||||||||||||||||
If requesting the inclusion of portfolio services charges in the management fee offset, please include the scope of the request in the space below as well. | |||||||||||||||||||||||||||||||||||||||||||||||
5.3 | Other Compensation | ||||||||||||||||||||||||||||||||||||||||||||||
Please describe any changes with respect to compensation, including bonuses, the principals earn outside this fund. | |||||||||||||||||||||||||||||||||||||||||||||||
5.4 | Fee Allocation | ||||||||||||||||||||||||||||||||||||||||||||||
If applicable, describe any changes to your policy on the allocation of fees, such as transaction fees, investment banking fees, | |||||||||||||||||||||||||||||||||||||||||||||||
monitoring fees, directors’ fees, etc., between the SBIC and any management or other affiliated entities. | |||||||||||||||||||||||||||||||||||||||||||||||
6 | Capitalization | ||||||||||||||||||||||||||||||||||||||||||||||
6.1 | Minimum Fundraising Threshold | ||||||||||||||||||||||||||||||||||||||||||||||
Identify your minimum to close, and discuss how your investment strategy, fund operations or other SBIC-related activities would change | |||||||||||||||||||||||||||||||||||||||||||||||
if you fail to reach your target fundraising level and must operate with this lower amount of capital. | |||||||||||||||||||||||||||||||||||||||||||||||
6.2 | Placement Agent | ||||||||||||||||||||||||||||||||||||||||||||||
Have you hired or do you intend to hire a Placement Agent? If "Yes", please enter the information under the "Service Providers" section of this Form 2181. | |||||||||||||||||||||||||||||||||||||||||||||||
If this is a new relationship or there is a change in duties or compensation, describe the duties of the agent and compensation structure below. | |||||||||||||||||||||||||||||||||||||||||||||||
6.3 | Investors | ||||||||||||||||||||||||||||||||||||||||||||||
List the names for investors who have "soft circle" committed to invest in the fund pending License approval. Note all new investors who did not invest in the most recently licensed fund. | |||||||||||||||||||||||||||||||||||||||||||||||
6.4 | Third-Party Borrowing and Capital Call Lines | ||||||||||||||||||||||||||||||||||||||||||||||
Do you have or do you intend to have any third party borrowing arrangements in place at any time prior to being licensed? "Yes" or "No" | |||||||||||||||||||||||||||||||||||||||||||||||
If “Yes,” please provide a description of your current or expected capital call and/or borrowing arrangements. If this is a leveraged licensing application, provide any associated borrowing agreements. | |||||||||||||||||||||||||||||||||||||||||||||||
(Please review 13 CFR 107.550) | |||||||||||||||||||||||||||||||||||||||||||||||
7 | Governance | ||||||||||||||||||||||||||||||||||||||||||||||
7.1 | Organizational Chart | ||||||||||||||||||||||||||||||||||||||||||||||
Are there any changes to the entities and persons related to the SBIC including any parent funds(s) or side-car vehicles if relevant? If yes, please describe the changes below. | |||||||||||||||||||||||||||||||||||||||||||||||
List the ownership percentages for the Applicant’s management company and General Partner. | |||||||||||||||||||||||||||||||||||||||||||||||
7.2 | Associates and Affiliated Entities – Service Providers | ||||||||||||||||||||||||||||||||||||||||||||||
Read the definition of Associate (13 CFR 107.50) and Affiliate (13 CFR 121.103). If there are new Associates or Affiliates, identify and describe these Associates | |||||||||||||||||||||||||||||||||||||||||||||||
and Affiliated individuals and entities that will provide services to the Applicant in connection with the | |||||||||||||||||||||||||||||||||||||||||||||||
Applicant’s activities as an SBIC, such as working capital, due diligence, deal sourcing, administration, or portfolio | |||||||||||||||||||||||||||||||||||||||||||||||
consulting, and explain how they will be compensated. If any individual or entity identified is an Associate or Affiliate of any other SBIC applicant or current licensed SBIC, please identify the relationship(s) and describe the nature of the relationship(s). | |||||||||||||||||||||||||||||||||||||||||||||||
7.3 | Advisory Committee or LPAC | ||||||||||||||||||||||||||||||||||||||||||||||
Are you making changes to your LP Advisory Committee? | |||||||||||||||||||||||||||||||||||||||||||||||
Do you intend to have any other type of new corporate, advisory or governance committee? | |||||||||||||||||||||||||||||||||||||||||||||||
If “Yes” to either question, please provide a brief description of the changes and other new committees. | |||||||||||||||||||||||||||||||||||||||||||||||
Explain the role and responsibilities of each committee, and any compensation you expect to provide to its members. | |||||||||||||||||||||||||||||||||||||||||||||||
7.4 | Personal Co-Investments | ||||||||||||||||||||||||||||||||||||||||||||||
If you are changing policies related to personal investments by principals and/or other employees in portfolio | |||||||||||||||||||||||||||||||||||||||||||||||
companies, please describe. | |||||||||||||||||||||||||||||||||||||||||||||||
7.5 | Limited Partner Co-Investments | ||||||||||||||||||||||||||||||||||||||||||||||
If you are changing policies regarding co-investments made by limited partners, please describe. | |||||||||||||||||||||||||||||||||||||||||||||||
7.6 | Other Co-Investments | ||||||||||||||||||||||||||||||||||||||||||||||
If you are changing policies regarding co-investments by any Affiliates and/or Associates, as defined in 13 CFR 107.50 and 13 CFR | |||||||||||||||||||||||||||||||||||||||||||||||
121.103, respectively, please describe. | |||||||||||||||||||||||||||||||||||||||||||||||
7.7 | Responsible Investing and Non-Discrimination Policies and Practices (Voluntary) | ||||||||||||||||||||||||||||||||||||||||||||||
7.7.1 | Do you maintain a formal ESG or Responsible Investing Policy? | ||||||||||||||||||||||||||||||||||||||||||||||
7.7.2 | If yes, what year was it established? | ||||||||||||||||||||||||||||||||||||||||||||||
7.7.3 | Do you maintain a formal Diversity, Equity and Inclusion Policy? | ||||||||||||||||||||||||||||||||||||||||||||||
7.7.4 | If yes, what year was it established? | ||||||||||||||||||||||||||||||||||||||||||||||
7.7.5 | As the mandate of the SBIC Program is to solve for capital access inadequacies for small businesses, SBA seeks address persistent shortfalls in access to capital for small businesses and startups across industries, geographies and communities. While not a requirement for licensing to invest in these areas, please check the box of all that apply to your investment strategy and focus. | ||||||||||||||||||||||||||||||||||||||||||||||
Responsible Investment Themes | Challenges Address by Investing in Companies Developing Solutions in These Areas: | ||||||||||||||||||||||||||||||||||||||||||||||
Climate Change | Mitigate and adapt to climate change | ||||||||||||||||||||||||||||||||||||||||||||||
Clean Energy | Accelerate the energy transformation to a low-carbon economy | ||||||||||||||||||||||||||||||||||||||||||||||
Biotech | Treatment and care of rare diseases | ||||||||||||||||||||||||||||||||||||||||||||||
Domestic Supply Chain & Manufacturing | Supply chain disruptions and a fragile domestic manufacturing ecosystem | ||||||||||||||||||||||||||||||||||||||||||||||
Cyber Security | Improved cyber and data security | ||||||||||||||||||||||||||||||||||||||||||||||
Inclusive Workforce and Non-discrimination | Persistent systemic racism has denied access and opportunities to build equity and participate in the labor force for many Americans | ||||||||||||||||||||||||||||||||||||||||||||||
Water | Global water scarcity and water quality crisis | ||||||||||||||||||||||||||||||||||||||||||||||
Nutrition | Reducing the global food production imbalance | ||||||||||||||||||||||||||||||||||||||||||||||
Health and Wellness | Improved mental and physical health | ||||||||||||||||||||||||||||||||||||||||||||||
Education | Equality of access to information and educational technologies and services | ||||||||||||||||||||||||||||||||||||||||||||||
Financial Inclusion | Improving financial wellness and building equity for all Americans | ||||||||||||||||||||||||||||||||||||||||||||||
Rural, LMI, and Opportunity Zone Businesses | Expanding access and opportunities to jobs, equity, services and technology | ||||||||||||||||||||||||||||||||||||||||||||||
Affordable Housing-Related Businesses | Largest shortfall in U.S. housing in 50 years | ||||||||||||||||||||||||||||||||||||||||||||||
8 | Attachments | ||||||||||||||||||||||||||||||||||||||||||||||
Please refer to the "Attachment Checklist" tab and submit the documents listed and check the box next to each item you have submitted. | |||||||||||||||||||||||||||||||||||||||||||||||
9 | SBIC Critical Technologies Initiative (SBICCT) Applicants Only | ||||||||||||||||||||||||||||||||||||||||||||||
9.1 | SBIC Critical Technologies (SBICCT) Applicants Only | ||||||||||||||||||||||||||||||||||||||||||||||
The SBICCT Initiative's mission is to increase investment opportunities in technology companies, critical industries, and capital-intensive small businesses addressing today’s most pressing national security supply chain needs. Please discuss the impact you expect your investment strategy will have on US national security and please justify your response. | |||||||||||||||||||||||||||||||||||||||||||||||
9.2 | The SBICCT Initiative requires at least 60% of all private capital and SBA leverage finance companies in one or multiple DoD Critical Technology Areas. Please detail the Critical Technology areas the proposed fund intends to invest in. If there are allocation targets by area, please describe. If you plan to invest in other technology areas, please describe these industries or technology verticals and the intended allocation. | ||||||||||||||||||||||||||||||||||||||||||||||
9.3 | The SBICCT Initiative is in support of U.S. national security. Do you intend to accept investment from non-U.S. entities and/or individuals? If yes, please list the countries you will consider. | ||||||||||||||||||||||||||||||||||||||||||||||
9.4 | Does your firm currently maintain relationships in other firm managed funds with non-U.S. investor entities and/or individuals? If yes, please list the countries and the number of investor and $ assets by country. | ||||||||||||||||||||||||||||||||||||||||||||||
9.5 | Are all Principals, Investors and Associates of the Applicant willing to undergo a U.S. Department of Defense background check? | ||||||||||||||||||||||||||||||||||||||||||||||
10 | Drop-Down Funds and Business Development Company (BDC) SBIC Applicants ONLY | ||||||||||||||||||||||||||||||||||||||||||||||
Is this a drop-down SBIC? | |||||||||||||||||||||||||||||||||||||||||||||||
10.1 | Capital | ||||||||||||||||||||||||||||||||||||||||||||||
How much capital do you intend to drop-down from the parent fund to the SBIC? | |||||||||||||||||||||||||||||||||||||||||||||||
$ | |||||||||||||||||||||||||||||||||||||||||||||||
10.2 | Parent Fund | ||||||||||||||||||||||||||||||||||||||||||||||
Describe the types of investments the parent currently makes or plans to make. Discuss how those | |||||||||||||||||||||||||||||||||||||||||||||||
investments and future investments may either be different from the SBIC’s investment strategy or how | |||||||||||||||||||||||||||||||||||||||||||||||
they will be similar. State what criteria will be utilized for determining into which fund an investment | |||||||||||||||||||||||||||||||||||||||||||||||
will be placed. Will you maintain a formal allocation policy to govern such decisions? | |||||||||||||||||||||||||||||||||||||||||||||||
Attachment Checklist | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
As of Date: 12/31/2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
This sheet lists all required attachments which must be submitted along with the MAQ Form 2181 for an application to be considered complete. As a reference, attachments and required later, at the time of Final License application are listed | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
✓ | Required | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
✓¹ | Submit final clean version and tracked changes version of documented submitted as part of the MAQ. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Required Item | Submit with MAQ | Submit with License Application | Guidance | ||||||||||||||||||||||||||||||||||||||||||||||||||||
1 | Private Placement Memorandum (PPM) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
2 | Limited Partnership Agreement (LPA) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
3 | General Partner Operating Agreement | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
4 | Side Letters | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
5 | Allocation Policy (if established) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
6 | ESG Policy (if established) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
7 | Diversity, Equity and Inclusion Policy (if established) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
8 | Valuation Policy | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
9 | Distribution Policy | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
10 | Management Agreement | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
11 | Investor Pitchbook | ✓ | |||||||||||||||||||||||||||||||||||||||||||||||||||||
12 | Contractual Agreements with Affiliated Entities | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
13 | Third-Party Debt Agreement(s) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
14 | Placement Agent Agreement(s) | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
15 | 10-year Licensee Cash Flow Forecast Model | ✓ | |||||||||||||||||||||||||||||||||||||||||||||||||||||
16 | Organizational Chart | ✓ | ✓¹ | submit redline version noting changes between most recent fund licensed and applicant fund. | |||||||||||||||||||||||||||||||||||||||||||||||||||
17 | MAQ Exhibits: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
(1) Exhibit A Activties Relationships Certification (2) Exhibit B Individual Declarations (3) Exhibit C Significant Investor Declarations (4) Exhibit D Individual Legal Questionnaire (5) Exhibit G Transferor's Liability Certificate |
✓ | ✓¹ | |||||||||||||||||||||||||||||||||||||||||||||||||||||
18 | MAQ Workbook tabs: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
(1) Info Release, (2) Overview, (3) Narrative, (4) Investment Track Record (for new principals only), (5) Principal Bios (for new principals only), (6) Small Business Impact, (7) Covenant Defaults, (8) Applicant Economics and Time, (9) Firm and Service Providers (10) Applicant Principals, (11) References (for new principals only) |
✓ | ✓¹ | |||||||||||||||||||||||||||||||||||||||||||||||||||||
19 | MAQ Application Fee | ✓ | |||||||||||||||||||||||||||||||||||||||||||||||||||||
20 | License Application Exhibits: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
(1) Exhibit E Legal Document Certification (2) Exhibit F Capital Certificate (3) Guaranty Agreement(s) |
✓ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
21 | Final Licensing Fee | ✓ | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Investment Track Record | |||||||||||||||||||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Company Financials at Time of Full Exit OR as of Valuation Date | Other Key Personnel Involved in Deal | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Firm name | Investment Vehicle (Fund) | Vintage Year | Size of Vehicle (if applicable) | Fund Style | Type of Investment | Deal Name (Company or Fund Investment) | Portfolio Company or Fund EIN # | Industry | State (Geography) | Sponsor (Name) | Lead Investor | Co-investors (Equity) | Co-Creditors (Debt) | Strategy | Venture/Expansion Stage | Equity Security | Debt Security / Loan | Purpose of Financing | Date of Inv. | Date of Full or Partial Exit | Invested Capital | Distributed (Realized) Value | Unrealized Value | Current Reported Value | Total Value | Cash Multiple (MOIC) | IRR | Sourced By | Led/Co-led Deal |
Board or Board Observer Seat | Data as of MM/DD/YYYY | Transaction Type | Valuation Methodology | Number of Employees | Enterprise Value | LTM Revenue | LTM EBITDA | Cash & Equivalents | Total Debt/Loans | Ownership % at Full Exit or as of Valuation Date | Financial Analysis/Market Research | Lead Structuring | Lead Due Diligence | Made Recommendation to Investment/Credit Committee | Investment/Credit Committee | Negotiation | Officer of the company | Board of Directors | Board Observer | Exit Process | |||
if applicable | if applicable | if applicable | if applicable | if applicable | 2-digit Abbreviation | Firm or Fund Name | Firm or Fund Name | Firm or Fund Name | Firm or Fund Name | The amount of capital distributed to Fund from the investment to date. | Current reported value for the investment (based on current fair market value / mark-to-market value). | "Total Value" is equal to "Current Reported Value" + "Amount Distributed". | Last Name, First Name | if applicable | fully diluted | Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
Last Name, First Name (if applicable) |
||||||||||||||||||||||||||||
Washington Widgets | Manufacturing | Mezzanine | Sub-Debt | Dec-05 | Jun-09 | $2.5 M | $3.1 M | $0.0 M | 1.24x | 15.4% | |||||||||||||||||||||||||||||||||||||||||||
Lincoln Group | Business Services | Special Situations | Sub-Debt | Mar-06 | Oct-10 | $1.8 M | $2.4 M | $0.0 M | 1.33x | 14.2% | |||||||||||||||||||||||||||||||||||||||||||
Jefferson Trucks | Trucking | Growth Stage | Common Equity | Apr-06 | Jun-07 | $5.3 M | $3.5 M | $0.0 M | 0.66x | (15.0%) | |||||||||||||||||||||||||||||||||||||||||||
Kennedy Textiles | Textiles | Hybrid Debt/Equity | Sub-Debt | Jun-06 | $1.5 M | $0.8 M | $2.0 M | 1.87x | 21.0% | ||||||||||||||||||||||||||||||||||||||||||||
VanBuren Windows | Manufacturing | Later Stage | Second Lien | Feb-07 | $2.4 M | $1.0 M | $1.5 M | 1.04x | 8.0% | ||||||||||||||||||||||||||||||||||||||||||||
Cleveland Communications | Communications | Later Stage | Sub-Debt w/Warrants | Aug-07 | $3.1 M | $2.1 M | $1.8 M | 1.26x | 16.0% | ||||||||||||||||||||||||||||||||||||||||||||
Wilson Components | Electronics | Later Stage | Senior Debt | Aug-07 | $2.0 M | $1.8 M | $0.5 M | 1.15x | 6.0% | ||||||||||||||||||||||||||||||||||||||||||||
(Note: If you need to insert additional rows, please do so above the last line) | TOTAL: | $18.6 M | $14.7 M | $5.8 M | 1.10x | 7.5% | <-- Gross IRR | ||||||||||||||||||||||||||||||||||||||||||||||
2.5% | <-- Net IRR (Gross IRR net of fees) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Description | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Please describe the investment experience presented above and why it is relevant to the SBIC proposal | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Please describe your role in making the investments described above. | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Footnotes: | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Include any footnotes below. | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Historical Cash Flows | |||||||||||||||||||||||
As of Date: | dd/mm/yyyy | ||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | ||||||||||||||||||||||
Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | Err:507 | ||||||||||||
Realized (R) or Unrealized (U): | Realized Investments | Unrealized Investments | TOTAL (Gross) | ||||||||||||||||||||
Company Name: | |||||||||||||||||||||||
Date of Initial Investment (Month-YY): | |||||||||||||||||||||||
Date of Exit (Month-YY): | |||||||||||||||||||||||
Loan/Debt/Equity/Other: | |||||||||||||||||||||||
Security Type: | |||||||||||||||||||||||
CALENDAR YEAR | |||||||||||||||||||||||
YYYY | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | ||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
YYYY | 0 | 0 | 0 | ||||||||||||||||||||
Enter Valuation Quarter Here: | 12/31/2012 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Total Residual Value | 0 | 0 | 0 | ||||||
Value of Outstanding Warrants (if applicable): | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Outstanding Warrants | 0 | 0 | 0 | |||||||
Realized (R) or Unrealized (U): | |||||||||||||||||||||||
Company Name: | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | #REF! | ||||||||||
Debt/Equity/Other: | Portfolio Summary Statistics | ||||||||||||||||||||||
Security Type: | Realized | Unrealized | Total Gross | Total Net | |||||||||||||||||||
IRR: | 0.0% | ||||||||||||||||||||||
IRR: | MOIC: | #DIV/0! | #DIV/0! | 0.00x | |||||||||||||||||||
Multiple of Invested Capital: | Proceeds/IC: | #DIV/0! | #DIV/0! | #DIV/0! | 0.00x | ||||||||||||||||||
Residual/IC: | #DIV/0! | #DIV/0! | #DIV/0! | 0.00x | |||||||||||||||||||
Invested Capital: | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||||
Percent of Cost: | No. of Companies: | 0 | 0 | 0 | |||||||||||||||||||
No. of Financings: | 0 | 0 | 0 | ||||||||||||||||||||
Total Cash and Non-Cash Proceeds: | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Invested Capital: | $0.0 M | $0.0 M | $0.0 M | |||||||
Residual Value: | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | % of Cost: | #DIV/0! | #DIV/0! | #DIV/0! | |||||||
Gain / (Loss): | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Gross Receipts: | $0.0 M | $0.0 M | $0.0 M | |||||||
Gross Residual Value: | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
Deal Lead: | Total Gross Gain/(Loss): | $0.0 M | $0.0 M | $0.0 M | |||||||||||||||||||
Deal Co-Lead: | |||||||||||||||||||||||
Deal Source: | Avg. Investment per Co.: | #DIV/0! | #DIV/0! | #DIV/0! | |||||||||||||||||||
Avg. Financing Size: | #DIV/0! | #DIV/0! | #DIV/0! | ||||||||||||||||||||
Hold Period (Years): | Med. Financing Size: | Err:507 | Err:507 | #VALUE! | |||||||||||||||||||
Current Pay (CP/NCP): | |||||||||||||||||||||||
% Ownership: | Inv w/Current Pay (%): | #DIV/0! | #DIV/0! | #DIV/0! | |||||||||||||||||||
Leverage Multiple: | Inv w/o Current Pay (%): | #DIV/0! | #DIV/0! | #DIV/0! | |||||||||||||||||||
Stage: | Volatility: | ||||||||||||||||||||||
Industry: | Downside Volatility: | 0.0% | |||||||||||||||||||||
Location: | Loss Rate: | #DIV/0! | #DIV/0! | #DIV/0! | |||||||||||||||||||
Initial Revenue: | Avg. Hold: | ||||||||||||||||||||||
Initial EBITDA: | |||||||||||||||||||||||
Small Business: | |||||||||||||||||||||||
Toggle: | |||||||||||||||||||||||
Company: | <># | ||||||||||||||||||||||
Realized (R) or Unrealized (U): | <># | R | U | ||||||||||||||||||||
Deal Lead: | <># | ||||||||||||||||||||||
Deal Co-Lead: | <># | ||||||||||||||||||||||
Deal Source: | <># | ||||||||||||||||||||||
Instrument: | <># | ||||||||||||||||||||||
Debt/Equity/Other: | <># | Debt | Equity | Other | |||||||||||||||||||
CP/NCP | <># | CP | |||||||||||||||||||||
Industry: | <># | ||||||||||||||||||||||
Stage: | <># | ||||||||||||||||||||||
State of Co's Primary Offices: | <># | ||||||||||||||||||||||
Small Business: | <># | Y | N | ||||||||||||||||||||
Min. Investment Size (= or >): | $0 M | $0.5 M | $1.0 M | $1.5 M | $2.0 M | $2.5 M | $3.0 M | $3.5 M | $4.0 M | $4.5 M | $5.0 M | $5.5 M | $6.0 M | ||||||||||
Max. Investment Size (= or <): | $150 M | $150 M | $149 M | $149 M | $148 M | $148 M | $147 M | $147 M | $146 M | $146 M | $145 M | $145 M | $144 M | ||||||||||
Min. Initial Revenue (= or >): | $0 M | $10 M | $20 M | $30 M | $40 M | $50 M | $60 M | $70 M | $80 M | $90 M | $100 M | $110 M | $120 M | ||||||||||
Max. Initial Revenue (= or <): | $2,000 M | $1,990 M | $1,980 M | $1,970 M | $1,960 M | $1,950 M | $1,940 M | $1,930 M | $1,920 M | $1,910 M | $1,900 M | $1,890 M | $1,880 M | ||||||||||
Min. Initial EBITDA (= or >): | ($500 M) | ($490 M) | ($480 M) | ($470 M) | ($460 M) | ($450 M) | ($440 M) | ($430 M) | ($420 M) | ($410 M) | ($400 M) | ($390 M) | ($380 M) | ||||||||||
Max. Initial EBITDA (= or <): | $2,000 M | $1,990 M | $1,980 M | $1,970 M | $1,960 M | $1,950 M | $1,940 M | $1,930 M | $1,920 M | $1,910 M | $1,900 M | $1,890 M | $1,880 M | ||||||||||
Min. Hold Period (= or >): | 0 | 0.5 | 1 | 1.5 | 2 | 2.5 | 3 | 3.5 | 4 | 4.5 | 5 | 5.5 | 6 | ||||||||||
Max Hold Period (= or <): | 150 | 149.5 | 149 | 148.5 | 148 | 147.5 | 147 | 146.5 | 146 | 145.5 | 145 | 144.5 | 144 | ||||||||||
Toggle: | <># | X | <>X |
Principal Biographies | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | |||||||||||||||||||||||||||||||||||||||||||||||||||||
For each principal please provide a brief biography and a description of his/her role within the team. Use the suggested format below, ensuring you include all previous employment and associated time periods. Enter this information on the "Principal bios" tab in this workbook. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Template | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
First Name Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||||
First Name Last Name is one of three General Partners at XYZ Capital and a member of the investment team. S/he joined XYZ Capital in 1995 as an Associate, was promoted to Partner in 2002 and General Partner in 2005. Prior to joining XYZ Capital, Last Name was an Associate with ABC Asset Management, where s/he worked from 1993 to 1995. S/he began her/his career as an Investment Banking Analyst at DEF Associates in 1990. Last Name earned a B.A. in Economics from ABC College in 1990 and an MBA from GHI University in 1993. |
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1 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
2 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
3 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
4 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
5 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
6 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
7 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
8 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
9 | First Name | Last Name | Title | |||||||||||||||||||||||||||||||||||||||||||||||||||
Small Business Impact | |||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | ||||||||||||||||||||||||||||||
This sheet should be completed to the best of the applicants knowledge. Only include deals attributable to principals of the applicant. | |||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | ||||||||||||||||||||||||||||||
All dollars in millions | Ownership* - "✓" all that apply *Ownership defined as owning >50% of the equity in the business or possessing voting control prior to investment. |
Founders - "✓" all that apply | CEO or Equivalent - "✓" all that apply | ||||||||||||||||||||||||||||
Gender | Ethnicity | Race | Gender | Ethnicity | Race | Gender | Ethnicity | Race | |||||||||||||||||||||||
Type of Investment | Deal Name (Company or Fund Investment) | Portfolio Company or Fund EIN # | Primary Industry NAICs Code | Industry | State (Geography) | Purpose of Financing | Date of Investment | Invested Capital | Distributed (Realized) Value | Unrealized Value | Current Reported Value | Total Value | Company Primary Contact Email Address | Website | Outside Entity | Prefer Not to Disclose | Prefer Not to Disclose | Prefer Not to Disclose | Veteran | Persons with Disabilities | Prefer Not to Disclose | Prefer Not to Disclose | Prefer Not to Disclose | Veteran | Persons with Disabilities | Prefer Not to Disclose | Prefer Not to Disclose | Prefer Not to Disclose | Veteran | Persons with Disabilities | |
0 | Washington Widgets | 0 | Manufacturing | 0 | 0 | 12/10/2005 | $2.5 M | $3.1 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | Lincoln Group | 0 | Business Services | 0 | 0 | 3/3/2006 | $1.8 M | $2.4 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | Jefferson Trucks | 0 | Trucking | 0 | 0 | 4/14/2006 | $5.3 M | $3.5 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | Kennedy Textiles | 0 | Textiles | 0 | 0 | 6/30/2006 | $1.5 M | $0.8 M | $2.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | VanBuren Windows | 0 | Manufacturing | 0 | 0 | 2/15/2007 | $2.4 M | $1.0 M | $1.5 M | $1.0 M | $0.0 M | ||||||||||||||||||||
0 | Cleveland Communications | 0 | Communications | 0 | 0 | 8/5/2007 | $3.1 M | $2.1 M | $1.8 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | Wilson Components | 0 | Electronics | 0 | 0 | 8/8/2007 | $2.0 M | $1.8 M | $0.5 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | 0 | 0 | 0 | 0 | 0 | 12/30/1899 | $0.0 M | $0.0 M | $0.0 M | $0.0 M | $0.0 M | ||||||||||||||||||||
0 | (Note: If you need to insert additional rows, please do so above the last line) | ||||||||||||||||||||||||||||||
0 | 0 | ||||||||||||||||||||||||||||||
0 | 0 | ||||||||||||||||||||||||||||||
0 | 0 |
Covenant Defaults | OMB Approval No. ####-#### | |||||||||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | Expiration Date MM/DD/YYYY | ||||||||||||||||||||||||||||||||||||||||||
This sheet must be completed by applicants submitting a business plan which includes loans or debt investments. Include any portfolio company investments which encounted a convent violation. Include for all principals of the applicant. | ||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | License no.: 01/23-4567 | ||||||||||||||||||||||||||||||||||||||||||
Portfolio Company Name | Portfolio Company EIN | Security Type | Covenant Violation, Restructing or Both | Covenant Violation Type | Date of Default (MM/DD/YYYY) | Time in Default (Months) | Default Interest Rate Charged | Principal Lead Last Name, First Name |
Discuss the reasoning behind any restructurings, the causes of any covenant violations and the measures taken to address these issues. | |||||||||||||||||||||||||||||||||||
x | x | x | x | x | x | |||||||||||||||||||||||||||||||||||||||
#VALUE! | ||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | |||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | |||||||||||||||||||||||||||||||||
Summary Table | Time Dedication to SBIC | Time Dedication: SBIC Activities | ||||||||||||||||||||||||||||||||
In the table below, please list the names of any person or entity which has a carried interest in the profits of the SBIC (parent if a drop-down), general partner, or management entity. List the Principals of the fund first followed by any other individuals or entities. For any non-Principals being allocated carried interest, list them by name, entity or category (such as "Employees" or "Carry Reserve") and provide the remaining requested information if available/relevant. |
Select the last name of each principal using the drop-down menu provided in the table below. Adjust the number of rows, if necessary. For each principal, estimate the percentage of time devoted to the SBIC at each of the three time intervals: 90 days after licensing, 18 months after licensing and in subsequent years. | Select the name of each principal using the drop-down menu provided in the table below. Adjust the number of rows, if necessary. For each principal, indicate how the time he/she will dedicate to the SBIC will be distributed across the various activities listed. Each row should sum to 100%. | ||||||||||||||||||||||||||||||||
Individual Name (Last, First) or Entity Name | Category | Carry Percentage Points (%) | LP/GP Contribution (% of Priv. Cap.) | Salary/Bonus | Time Commitment to SBIC (%) | Investment Committee Member | 90 Days after Licensing | 18 Months after Licensing | Subsequent Years | Deal Sourcing | Deal Execution | Portfolio Monitoring & Management | Fund Operations and Compliance | Fundraising | Investor Relations | Fund Finance and Accounting | Other | Total | ||||||||||||||||
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0% | <--- Insert additional rows, as necessary |
Firm and Service Providers | |||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | ||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | ||||||||||||||||||||||||||||||||
Firm Information | |||||||||||||||||||||||||||||||||
Enter the requested information. Select from the drop-down menu where available. The EIN should be provided for the fund entity and is required for inclusion in License Applications only, though you may provide it as part of your MAQ submission if it is available. | |||||||||||||||||||||||||||||||||
Full Legal Name of Firm Manaing / Sponsoring Applicant | Firm EIN |
Main Telephone ###-###-#### |
Main E-mail | Website | |||||||||||||||||||||||||||||
Address 1 | Address 2 | City | State | ZIP Code | Country | ||||||||||||||||||||||||||||
Headquarters: | |||||||||||||||||||||||||||||||||
Branch Offices (if any): | |||||||||||||||||||||||||||||||||
Service Providers | |||||||||||||||||||||||||||||||||
Please use the table below to list any law firms, accounting firms, placement agents, or consultants you are currently employing or any firm that will be compensated for assisting you in any manner to obtain an SBIC license. If a person, group or entity has made any contributions (whether financial or non-financial) that entitle it or them to any type of equity or economic participation in the SBIC, very briefly describe the nature of such contribution. | |||||||||||||||||||||||||||||||||
Entity/Person Name | Provider Category | City | State | Year Relationship Established | Key Contact First Name | Key Contact Last Name | Key Contact Title | Phone ###-###-#### |
Description of Contribution (If applicable) | ||||||||||||||||||||||||
Principal Information | OMB Approval No. ####-#### | |||||||||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | Expiration Date MM/DD/YYYY | ||||||||||||||||||||||||||||||||||||||||||
Enter the requested information for the Principals of the fund ONLY, beginning with the Principal serving as the applicant's primary contact with SBA. For the purposes of the SBIC application process, the term "Principal" refers to any individual who engages or proposes to engage in the management of the applicant, and customarily includes officers and directors of a corporation, general partners of a partnership, and managers of a limited liability company. However, it may also include other individuals, especially if they have a vote or a veto in the investment decision-making process. | ||||||||||||||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | |||||||||||||||||||||||||||||||||||||||||||
Note: Demographic information is provided on a voluntary basis. | Voluntary Demographic Information ("✓" all that apply) | |||||||||||||||||||||||||||||||||||||||||||
✓- Yes; blank - No | Gender | Ethnicity | Race | |||||||||||||||||||||||||||||||||||||||||
Last Name | First Name | Title | U.S. Citizen | Permanent Resident Alien | Role Type | Business Address 1 | Business Address 2 | Business City | Business State | Business ZIP Code | Business Country | Business Phone | Business Email | Home Address 1 | Home Address 2 | Home City | Home State | Home ZIP Code | Home Country | Mobile Telephone | Personal E-mail | GP Ownership % | Fund Carry % | Management Company Ownership % | Investment Committee Member | Primary SBA Contact | SBA Mailing List? | Male | Female | X | Prefer Not to Disclose | Non-Hispanic or Latino | Hispanic or Latino | Prefer Not to Disclose | American Indian or Alaska Native | Asian | Black or African American | Native Hawaiian or Other Pacific Islander | White | Prefer Not to Disclose | Veteran | Persons with Disabilities | ||
Smith | Mary | CFO | Finance and Operations | (703) 861-3642 | MarySmith@abc.com | 5% | ✓ | ✓ | ✓ | |||||||||||||||||||||||||||||||||||
References | OMB Approval No. ####-#### | |||||||||||||||||||||||||||||||||||||
As of Date: | dd/mm/yyyy | Expiration Date MM/DD/YYYY | ||||||||||||||||||||||||||||||||||||
Name of Applicant: | Applicant Fund Name | License no.: 01/23-4567 | ||||||||||||||||||||||||||||||||||||
References | ||||||||||||||||||||||||||||||||||||||
Firm/ Organization |
First Name | Last Name | Title | Current Firm | Reference Type | Associated Fund or Co. | Associated Portfolio Company | Start Year of Relationship | Work Phone | Mobile Phone | Home Phone | E-mail 1 | E-mail 2 | Notes |
Fund Style | Fund Strategy | Industry | SBICCT Areas | Type of Investment | Status | Transaction Type | State/Territory | Venture/Expansion Stage | Equity Security | Debt Security / Loan | Rate Structure | Geo/Regional Focus | Binary | Board Status | Monitoring | Types of Licensees | Limited Partnership | ✓ | Countries | Carry Econ Category | ||||||||||||||||
Fund of Funds | Venture | Diversified | Biotechnology | Equity Fund Investment | Realized | Change of Control | AK | Pre-Seed | Preferred Equity | Senior Secured Debt | Fixed Rate | U.S. Nationwide | Yes | Board Observer | No Change | Non-Leveraged | Limited Liability Corporation | Covenant Violation | United States of America (USA) | Principal | ||||||||||||||||
Venture | Growth Equity | Multi-Sector (Less than/Equal to 3 Sectors) | Quantum Science | Direct Equity Investment | Partially Realized | Platform Acquisition | AL | Seed | Common Equity | Senior Unsecured Debt | Floating Rate | East Coast | No | Board Member | Change Implemented | Standard Debenture SBIC | C-Corp | Restructuring | Afghanistan | Employee | ||||||||||||||||
Growth Equity | Buyout | Business Products & Services | FutureG | Co-investment | Unrealized | Initial Public Offering | AR | Post-Seed | Convertible Note | Unitrache Debt | Midwest | N/A | N/A | Intend to Change | Accrual SBIC | Both | Accounting & Tax | Albania | Member of the GP (non-Principal) | |||||||||||||||||
Secondaries | Special Situations | Education | Advanced Materials | Structured Credit | Merger | AZ | A | SAFE Note | Subordinated Debt with Warrants | West Coast | Reinvestor SBIC | Depository Bank and Lender | Algeria | Management Company Owner (non-Principal) | ||||||||||||||||||||||
Private Credit | Distressed | Personal Care | Trusted AI and Autonomy | Long-term Loan | Secondary Sale | CA | B | Subordinated Debt without Warrants | South | Bank-Owned SBIC | IT Services | Andorra | Charitable Donation | |||||||||||||||||||||||
Private Equity | Mezzanine | Food, Beverage & Tobacco | Integrated Network Systems-of-Systems | Royalty or Revenue-Based Investment | Sale to Strategic Buyer | CO | C | Subordinated Debt with PIK Notes | Southeast | Business Development Company (BDC) Standard Debenture | Fund Administration and Reporting | Angola | Other Non-Profit | |||||||||||||||||||||||
Hybrid | Direct Lending | Household Products | Microelectronics | Leveraged Buyout | Sale to Financial Buyer | CT | D | Royalty | Southwest | To-Be-Determined | Legal Counsel | Anguilla | Carry Reserve for Future Hires or Promotion | |||||||||||||||||||||||
Fund Secondary | Retailing and Distribution | Space Technology | Liquidation/Sale of Assets | DC | E | Revenue-Based Loan | Northwest | Placement Agent | Antigua & Barbuda | Carry Reserve for Performance Incentive | ||||||||||||||||||||||||||
Direct Secondary | Consumer Services | Renewable Energy Generation and Storage | Growth Financing | DE | Loan | Northeast | Outsourced HR Services | Argentina | Other | |||||||||||||||||||||||||||
Co-Investment | Consumer Durables and Apparel | Advanced Computing and Software | Restructuring | FL | South Central | Retirement Benefits | Armenia | |||||||||||||||||||||||||||||
Multiple | Media & Entertainment | Human-Machine Interfaces | Bridge Loan | GA | Mid-Atlantic | Business Insurance Provider | Australia | |||||||||||||||||||||||||||||
Seed | Industrials | Directed Energy | Seed Financing | HI | Office Leasor / Workspace Provider | Austria | ||||||||||||||||||||||||||||||
Early Venture | Materials | Hypersonics | IA | Regulatory Compliance | Azerbaijan | |||||||||||||||||||||||||||||||
Late Venture | Manufacturing | Integrated Sensing and Cyber | ID | Outsourced CFO Services | Bahamas | |||||||||||||||||||||||||||||||
Expansion | Transportation | IL | Heath Insurance Provider | Bahrain | ||||||||||||||||||||||||||||||||
Balanced Venture | Energy | IN | GP Stake Provider | Bangladesh | ||||||||||||||||||||||||||||||||
Co-Investments | Software | KS | Other | Barbados | ||||||||||||||||||||||||||||||||
Hybrid Debt/Equity | IT Services | KY | Belarus | |||||||||||||||||||||||||||||||||
Venture Debt | Semiconductors and Semiconductor Equipment | LA | Belgium | |||||||||||||||||||||||||||||||||
Angel | Telecommunication Services | MA | Belize | |||||||||||||||||||||||||||||||||
Technology Hardware and Equipment | MD | Benin | ||||||||||||||||||||||||||||||||||
Healthcare | ME | Bermuda | ||||||||||||||||||||||||||||||||||
Pharma, Biotech & Life Sciences | MI | Bhutan | ||||||||||||||||||||||||||||||||||
Medical Devices & Equipment | MN | Bolivia | ||||||||||||||||||||||||||||||||||
Healthcare Services | MO | Bosnia & Herzegovina | ||||||||||||||||||||||||||||||||||
Banks | MS | Botswana | ||||||||||||||||||||||||||||||||||
Diversified Financials | MT | Brazil | ||||||||||||||||||||||||||||||||||
Defense | Multiple | Brunei Darussalam | ||||||||||||||||||||||||||||||||||
Insurance | NC | Bulgaria | ||||||||||||||||||||||||||||||||||
Other | ND | Burkina Faso | ||||||||||||||||||||||||||||||||||
NE | Burundi | |||||||||||||||||||||||||||||||||||
NH | Cambodia | |||||||||||||||||||||||||||||||||||
NJ | Cameroon | |||||||||||||||||||||||||||||||||||
NM | Canada | |||||||||||||||||||||||||||||||||||
Non-US | Cape Verde | |||||||||||||||||||||||||||||||||||
NV | Cayman Islands | |||||||||||||||||||||||||||||||||||
NY | Central African Republic | |||||||||||||||||||||||||||||||||||
OH | Chad | |||||||||||||||||||||||||||||||||||
OK | Chile | |||||||||||||||||||||||||||||||||||
OR | China | |||||||||||||||||||||||||||||||||||
PA | China - Hong Kong / Macau | |||||||||||||||||||||||||||||||||||
PR | Colombia | |||||||||||||||||||||||||||||||||||
RI | Comoros | |||||||||||||||||||||||||||||||||||
SC | Congo | |||||||||||||||||||||||||||||||||||
SD | Congo, Democratic Republic of (DRC) | |||||||||||||||||||||||||||||||||||
TN | Costa Rica | |||||||||||||||||||||||||||||||||||
TX | Croatia | |||||||||||||||||||||||||||||||||||
UT | Cuba | |||||||||||||||||||||||||||||||||||
VA | Cyprus | |||||||||||||||||||||||||||||||||||
VT | Czech Republic | |||||||||||||||||||||||||||||||||||
WA | Denmark | |||||||||||||||||||||||||||||||||||
WI | Djibouti | |||||||||||||||||||||||||||||||||||
WV | Dominica | |||||||||||||||||||||||||||||||||||
WY | Dominican Republic | |||||||||||||||||||||||||||||||||||
GUAM | Ecuador | |||||||||||||||||||||||||||||||||||
Egypt | ||||||||||||||||||||||||||||||||||||
El Salvador | ||||||||||||||||||||||||||||||||||||
Equatorial Guinea | ||||||||||||||||||||||||||||||||||||
Eritrea | ||||||||||||||||||||||||||||||||||||
Estonia | ||||||||||||||||||||||||||||||||||||
Eswatini | ||||||||||||||||||||||||||||||||||||
Ethiopia | ||||||||||||||||||||||||||||||||||||
Fiji | ||||||||||||||||||||||||||||||||||||
Finland | ||||||||||||||||||||||||||||||||||||
France | ||||||||||||||||||||||||||||||||||||
French Guiana | ||||||||||||||||||||||||||||||||||||
Gabon | ||||||||||||||||||||||||||||||||||||
Gambia, Republic of The | ||||||||||||||||||||||||||||||||||||
Georgia | ||||||||||||||||||||||||||||||||||||
Germany | ||||||||||||||||||||||||||||||||||||
Ghana | ||||||||||||||||||||||||||||||||||||
Great Britain | ||||||||||||||||||||||||||||||||||||
Greece | ||||||||||||||||||||||||||||||||||||
Grenada | ||||||||||||||||||||||||||||||||||||
Guadeloupe | ||||||||||||||||||||||||||||||||||||
Guatemala | ||||||||||||||||||||||||||||||||||||
Guinea | ||||||||||||||||||||||||||||||||||||
Guinea-Bissau | ||||||||||||||||||||||||||||||||||||
Guyana | ||||||||||||||||||||||||||||||||||||
Haiti | ||||||||||||||||||||||||||||||||||||
Honduras | ||||||||||||||||||||||||||||||||||||
Hungary | ||||||||||||||||||||||||||||||||||||
Iceland | ||||||||||||||||||||||||||||||||||||
India | ||||||||||||||||||||||||||||||||||||
Indonesia | ||||||||||||||||||||||||||||||||||||
Iran | ||||||||||||||||||||||||||||||||||||
Iraq | ||||||||||||||||||||||||||||||||||||
Israel and the Occupied Territories | ||||||||||||||||||||||||||||||||||||
Italy | ||||||||||||||||||||||||||||||||||||
Ivory Coast (Cote d'Ivoire) | ||||||||||||||||||||||||||||||||||||
Jamaica | ||||||||||||||||||||||||||||||||||||
Japan | ||||||||||||||||||||||||||||||||||||
Jordan | ||||||||||||||||||||||||||||||||||||
Kazakhstan | ||||||||||||||||||||||||||||||||||||
Kenya | ||||||||||||||||||||||||||||||||||||
Korea, Democratic Republic of (North Korea) | ||||||||||||||||||||||||||||||||||||
Korea, Republic of (South Korea) | ||||||||||||||||||||||||||||||||||||
Kosovo | ||||||||||||||||||||||||||||||||||||
Kuwait | ||||||||||||||||||||||||||||||||||||
Kyrgyz Republic (Kyrgyzstan) | ||||||||||||||||||||||||||||||||||||
Laos | ||||||||||||||||||||||||||||||||||||
Latvia | ||||||||||||||||||||||||||||||||||||
Lebanon | ||||||||||||||||||||||||||||||||||||
Lesotho | ||||||||||||||||||||||||||||||||||||
Liberia | ||||||||||||||||||||||||||||||||||||
Libya | ||||||||||||||||||||||||||||||||||||
Liechtenstein | ||||||||||||||||||||||||||||||||||||
Lithuania | ||||||||||||||||||||||||||||||||||||
Luxembourg | ||||||||||||||||||||||||||||||||||||
Madagascar | ||||||||||||||||||||||||||||||||||||
Malawi | ||||||||||||||||||||||||||||||||||||
Malaysia | ||||||||||||||||||||||||||||||||||||
Maldives | ||||||||||||||||||||||||||||||||||||
Mali | ||||||||||||||||||||||||||||||||||||
Malta | ||||||||||||||||||||||||||||||||||||
Martinique | ||||||||||||||||||||||||||||||||||||
Mauritania | ||||||||||||||||||||||||||||||||||||
Mauritius | ||||||||||||||||||||||||||||||||||||
Mayotte | ||||||||||||||||||||||||||||||||||||
Mexico | ||||||||||||||||||||||||||||||||||||
Moldova, Republic of | ||||||||||||||||||||||||||||||||||||
Monaco | ||||||||||||||||||||||||||||||||||||
Mongolia | ||||||||||||||||||||||||||||||||||||
Montenegro | ||||||||||||||||||||||||||||||||||||
Montserrat | ||||||||||||||||||||||||||||||||||||
Morocco | ||||||||||||||||||||||||||||||||||||
Mozambique | ||||||||||||||||||||||||||||||||||||
Myanmar/Burma | ||||||||||||||||||||||||||||||||||||
Namibia | ||||||||||||||||||||||||||||||||||||
Nepal | ||||||||||||||||||||||||||||||||||||
Netherlands | ||||||||||||||||||||||||||||||||||||
New Zealand | ||||||||||||||||||||||||||||||||||||
Nicaragua | ||||||||||||||||||||||||||||||||||||
Niger | ||||||||||||||||||||||||||||||||||||
Nigeria | ||||||||||||||||||||||||||||||||||||
North Macedonia, Republic of | ||||||||||||||||||||||||||||||||||||
Norway | ||||||||||||||||||||||||||||||||||||
Oman | ||||||||||||||||||||||||||||||||||||
Pacific Islands | ||||||||||||||||||||||||||||||||||||
Pakistan | ||||||||||||||||||||||||||||||||||||
Panama | ||||||||||||||||||||||||||||||||||||
Papua New Guinea | ||||||||||||||||||||||||||||||||||||
Paraguay | ||||||||||||||||||||||||||||||||||||
Peru | ||||||||||||||||||||||||||||||||||||
Philippines | ||||||||||||||||||||||||||||||||||||
Poland | ||||||||||||||||||||||||||||||||||||
Portugal | ||||||||||||||||||||||||||||||||||||
Puerto Rico | ||||||||||||||||||||||||||||||||||||
Qatar | ||||||||||||||||||||||||||||||||||||
Reunion | ||||||||||||||||||||||||||||||||||||
Romania | ||||||||||||||||||||||||||||||||||||
Russian Federation | ||||||||||||||||||||||||||||||||||||
Rwanda | ||||||||||||||||||||||||||||||||||||
Saint Kitts and Nevis | ||||||||||||||||||||||||||||||||||||
Saint Lucia | ||||||||||||||||||||||||||||||||||||
Saint Vincent and the Grenadines | ||||||||||||||||||||||||||||||||||||
Samoa | ||||||||||||||||||||||||||||||||||||
Sao Tome and Principe | ||||||||||||||||||||||||||||||||||||
Saudi Arabia | ||||||||||||||||||||||||||||||||||||
Senegal | ||||||||||||||||||||||||||||||||||||
Serbia | ||||||||||||||||||||||||||||||||||||
Seychelles | ||||||||||||||||||||||||||||||||||||
Sierra Leone | ||||||||||||||||||||||||||||||||||||
Singapore | ||||||||||||||||||||||||||||||||||||
Slovak Republic (Slovakia) | ||||||||||||||||||||||||||||||||||||
Slovenia | ||||||||||||||||||||||||||||||||||||
Solomon Islands | ||||||||||||||||||||||||||||||||||||
Somalia | ||||||||||||||||||||||||||||||||||||
South Africa | ||||||||||||||||||||||||||||||||||||
South Sudan | ||||||||||||||||||||||||||||||||||||
Spain | ||||||||||||||||||||||||||||||||||||
Sri Lanka | ||||||||||||||||||||||||||||||||||||
Sudan | ||||||||||||||||||||||||||||||||||||
Suriname | ||||||||||||||||||||||||||||||||||||
Sweden | ||||||||||||||||||||||||||||||||||||
Switzerland | ||||||||||||||||||||||||||||||||||||
Syria | ||||||||||||||||||||||||||||||||||||
Tajikistan | ||||||||||||||||||||||||||||||||||||
Tanzania | ||||||||||||||||||||||||||||||||||||
Thailand | ||||||||||||||||||||||||||||||||||||
Timor Leste | ||||||||||||||||||||||||||||||||||||
Togo | ||||||||||||||||||||||||||||||||||||
Trinidad & Tobago | ||||||||||||||||||||||||||||||||||||
Tunisia | ||||||||||||||||||||||||||||||||||||
Türkiye (Turkey) | ||||||||||||||||||||||||||||||||||||
Turkmenistan | ||||||||||||||||||||||||||||||||||||
Turks & Caicos Islands | ||||||||||||||||||||||||||||||||||||
Uganda | ||||||||||||||||||||||||||||||||||||
Ukraine | ||||||||||||||||||||||||||||||||||||
United Arab Emirates | ||||||||||||||||||||||||||||||||||||
United States of America (USA) | ||||||||||||||||||||||||||||||||||||
Uruguay | ||||||||||||||||||||||||||||||||||||
Uzbekistan | ||||||||||||||||||||||||||||||||||||
Venezuela | ||||||||||||||||||||||||||||||||||||
Vietnam | ||||||||||||||||||||||||||||||||||||
Virgin Islands (UK) | ||||||||||||||||||||||||||||||||||||
Virgin Islands (US) | ||||||||||||||||||||||||||||||||||||
Yemen | ||||||||||||||||||||||||||||||||||||
Zambia | ||||||||||||||||||||||||||||||||||||
Zimbabwe |
File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |